I was diagnosed with bipolar and psychosis almost four years ago, and I was on medication but stopped when I found out I was pregnant. Since finding out I have seen my psychologist once and my case manager has cancelled previous appointments as she couldn't make them, although she re booked for the 29th may. She sent me a text saying she would like to discuss discharging me from the early intervention team, but I feel since finding out im pregnant things have been worse than ever, but I always feel like im pestering people if I ask for help

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Don't let them discharge you, it's ok to ask for help & you shouldn't be made to feel bad about it. They should also be making a care plan for you just in case your mental health deteriorates. Please take any help you can get & take care of yourself xx

congratulations on your pregnancy. It doesn't sound as if you're getting much help from health professionals but don't worry, you're not alone and you have the right to help and advice which will mean you can plan how you want things to go and prepare so that your pregnancy and birth will result in the best outcome: a healthy, happy mum and baby.

If you're not getting much help from your case manager, would it be an idea to go to your GP and ask for referral to the perinatal psychiatry service? Hopefully you will be then be referred to a specialist perinatal psychiatrist who is in the best position to give you expert advice about medication, treatment and how to make a birth plan. If you look on the APP site under the tab 'What is PP?' and go to Books and Resources, you'll find a leaflet on 'Bipolar, Pregnancy and Childbirth' which will give you more info on what to expect and how you can access services.

The health services in some areas are poorly organised to help women in your situation (something APP and Bipolar UK are campaigning hard to change), but it may be worth pointing out to your case manager or GP that the NICE guidelines recommend referral to a perinatal psychiatrist. Below is an excerpt:

"More frequent contact by specialist mental health services (including, where appropriate, specialist perinatal mental health services), working closely with maternity services, should be considered for pregnant women with bipolar disorder, because of the increased risk of relapse during pregnancy and the postnatal period,below is an excerpt:

1.7.1.3 A written plan for managing a woman's bipolar disorder during the pregnancy, delivery and postnatal period should be developed as soon as possible. This should be developed with the patient and significant others, and shared with her obstetrician, midwife, GP and health visitor. All medical decisions should be recorded in all versions of the patient's notes. Information about her medication should be included in the birth plan and notes for postnatal care."

If you want to talk to someone about it, email info@bipolaruk.org.uk and mark it "for the attention of Clare Dolman"

As Kellbell says, you shouldn't feel bad about asking: they are not providing the service they should be.

Ask for help, and tell them you want to sort out a care plan, and that you are feeling very vulnerable. I think you can also get yourself referred to see Dr Ian Jones here: app-network.org/what-is-pp/... if you are in the UK. I did, and it really helped, a lot. I am 28 weeks preg, living in Germany, and I have found a specialist in perinatal mental health, I am seeing this Friday. Tell your midwives about it, tell any consultants about it, and draw up a plan for what you want. Include friends and family in a support plan for after the birth too, and ask people now if they will be willing to help with dropping around a meal, keeping an eye on you, doing the hoovering, etc. You must ask for help, hon. It is hard, I find it difficult, but I have been really touched by peoples willingness to help me out. Write down how you are feeling, and send it to the case manager, and explain that if they are discharging you from the Early Discharge team, a: you don't feel ready, and b: You need to be discharged to someone/a team who can help you. Be very clear with them, about what support that you do feel will be helpful. Did you come off the meds quickly, and unsupervised? If so, you really need to make sure you get the support in place, as the risk of relapse can be higher in these cases. Take Care of yourself, and if you feel awkward about asking, remember it's not just for you, it is for your little one, and by being proactive now, you have more chance being exactly the kind of mum you want to be. xx

Hi Cherry5909, in addition to all the really excellent advice above, here's the link to the 'Bipolar Disorder & Pregnancy' page with lots of info, links & the link to the 'Bipolar, Pregnancy and Childbirth' leaflet that Florence21 mentions: app-network.org/what-is-pp/...

Try not to feel bad about seeming to pester people, I'm sure you're not pestering - it sounds perfectly reasonable to me to keep chasing them. As Dennypixie says, you're doing absolutely the right thing by being proactive getting the right info & care you need. It can be pretty difficult to get at times so just keep asking the questions until you get the help that you need & deserve. It's really good that you've got plenty of time to go through all the info available & that you'll be well informed & well prepared - great stuff!

As others have said, you are doing exactly the right thing to be seeking support and a care plan for your pregnancy and birth. It must have been very worrying for you when your case manager raised the idea of discharging you from the service. As Florence21 says, good practice guidelines state that you should ideally have access to specialist perinatal mental health services, and a care plan which is shared with your midwife, health visitor, obstetrician and GP.

How are things? Have you been able to get any further with support for you during your pregnancy?

One thing you could request from your midwife if there is no specialist perinatal service in your area is to see an obstetrician regularly during your pregnancy and discuss your concerns about medication with him/her. Although not specifically trained in mental health, obstetricians often support women taking many different types of medication for their physical or mental health.

If you want to chat more about your care plan there are lots of mums on the forum with experience of planning during pregnancy.

Thank you all for your comments, they are much appreciated. Well I saw my case manager yesterday, and she said that it looks like we are back to square one, which I wasn't entirely sure as to what she meant by that. But she has made a list of my needs and she said she would try help me through them and get me the support, I am back to seeing my old psychologist and she has also made an appointment with a psychiatrist to discuss possible medications. I will also beig seeing my case manager next friday. Hopefully this is the start of good things and getting myself on track